<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191570895
Report Date: 12/01/2022
Date Signed: 12/01/2022 03:20:55 PM


Document Has Been Signed on 12/01/2022 03:20 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:LINDBERGH FULL DAYFACILITY NUMBER:
191570895
ADMINISTRATOR:VERONICA BLOOMFIELDFACILITY TYPE:
850
ADDRESS:12120 LINDBERGH ROADTELEPHONE:
(310) 631-7308
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY:73CENSUS: 15DATE:
12/01/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Maria Marquez, Teacher TIME COMPLETED:
03:40 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 12/01/2022 at 2:15 PM, Licensing Program Analyst (LPA) Katrina Chicote conducted an unannounced case management inspection to follow up on an incident that was reported to the Department on 10/26/2022. Upon arrival, LPA met with Gisele Ochoa, Administrator who reported the incident to Department. LPA arrived at facility during nap time and observed 15 children napping on blue cots with three staff at time of inspection.

On 10/26/2022, an incident was reported to the department where a child was observed by a teacher engaging in inappropriate behavior on the play structure with another child. The facility reported this incident to the Department within the required 24 hours and submitted the written report within the required seven days.

During this inspection LPA interviewed staff who were present for the incident though they state they did not witness it themselves, staff who was listed on report as witnessing incident was not present at facility during inspection. Both staff interviewed provided consistent statements that incident was witnessed by staff member indicated on report. LPA discussed outside supervision procedures with S1. Staff interviews state that the incident was discussed with Authorized Representatives as well as children involved to provide redirection on behaviors.

LPA observed outside play yard and structure where incident took place. LPA obtained and reviewed documentation. Based on the information obtained and LPA observation of the play area, LPA determined there was adequate supervision provided the day of the incident.
Report Continues - Page 1 of 2
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:
DATE: 12/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754
FACILITY NAME: LINDBERGH FULL DAY
FACILITY NUMBER: 191570895
VISIT DATE: 12/01/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The facility was found in compliance per Title 22 regulations, there will be no deficiencies cited today, 12/01/2022.

The Notice of Site Visit (LIC 9213) – must remain posted for 30 days during the hours of operation after each site inspection by a licensing representative. Failure to maintain posting as required will result in a civil penalty of $100.00.



Exit interview was conducted and report was reviewed with the Licensee (or facility representative), Maria Marquez.
Report Ends - Page 2 of 2
SUPERVISOR'S NAME: Trevino CochranTELEPHONE: (323) 981-3385
LICENSING EVALUATOR NAME: Katrina ChicoteTELEPHONE: (323) 629-7658
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2